| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
5,658 |
2,897 |
$359K |
| D1351 |
Sealant - per tooth |
5,166 |
2,344 |
$314K |
| D4341 |
|
2,242 |
1,169 |
$309K |
| D1120 |
Prophylaxis - child |
7,105 |
6,823 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
10,154 |
9,771 |
$277K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,104 |
6,832 |
$181K |
| D2160 |
|
2,020 |
1,518 |
$173K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,534 |
1,809 |
$172K |
| D1110 |
Prophylaxis - adult |
3,703 |
3,608 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,897 |
4,751 |
$109K |
| D0274 |
Bitewings - four radiographic images |
5,976 |
5,842 |
$106K |
| D2332 |
|
998 |
604 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
4,251 |
4,073 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
11,031 |
10,551 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,508 |
5,937 |
$61K |
| D0272 |
Bitewings - two radiographic images |
3,105 |
2,964 |
$30K |
| D2140 |
|
539 |
434 |
$24K |
| D5120 |
|
38 |
38 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
199 |
$16K |
| D5110 |
|
28 |
28 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
108 |
69 |
$10K |
| D2335 |
|
66 |
48 |
$7K |
| D2330 |
|
109 |
74 |
$6K |
| D4342 |
|
40 |
28 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
74 |
62 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
145 |
143 |
$2K |
| D2161 |
|
15 |
12 |
$928.80 |
| D2940 |
|
29 |
24 |
$350.30 |
| D1999 |
|
712 |
517 |
$0.00 |